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This chapter discusses the history of the approach of medicine to cancer, which is considered to be a paradigmatic example of medicine's great concern with advancing scientific knowledge. The historical understanding of cancer is first provided, followed by an attempt to determine whether cancer mortality is increasing or not. Various cancer researches conducted in countries all over the globe are examined, along with the development of cancer services and treatment.

As medical cancer treatments become more and more successful, a growing cohort of cancer survivors is emerging. Maintaining effective communication with survivors poses a host of new challenges that have not received much attention in the literature to date. This chapter covers a number of areas relevant to enhancing communication with survivors including: various definitions of who is considered a cancer survivor; prevalence of survivors; key issues faced by cancer survivors; coping strategies, including the use of care plans and clinical practice guidelines; communication challenges with cancer survivors; models for survivorship care and details about communication techniques in the survivorship consultation. It examines the issues that are important for ongoing care and communication with cancer patients who will go on to live post-treatment and require continuity of care for many years.

Infertility is a consequence of many cancer diagnoses and/or treatments for both male and female patients. This is particularly true for those who require cancer treatment comprised of high-dose chemotherapy, combination chemotherapy, radiation therapy to the pelvis, and/or surgical removal of the reproductive organs as part of their cancer treatment. While the issues of prognosis, survival, and treatment regimen decisions initially generally assume prime importance, the communication of risk information regarding fertility is usually presented in the context of other potential cancer treatment side effects. Parenthood for many cancer patients is a fundamental goal of cancer survivorship. Studies documenting the attitudes of young cancer survivors have revealed that parenthood is viewed as a positive experience. This chapter discusses the reproductive options for cancer survivors and outcomes for patients and families resulting from communication.

This chapter reviews information regarding conducting and analyzing trials designed to test potential agents for alleviating cancer-related anorexia/cachexia. The information was derived from experience generated by the North Central Cancer Treatment Group (NCCTG) in conducting a series of ten trials which, to date, have entered over 2000 patients. As with any research endeavor, the study of anorexia/cachexia is difficult and fraught with potential pitfalls. The discussion here may aid in the standardization of design and analytic approaches for anorexia/cachexia trials so that a meta-analytic process, formal or otherwise, may be facilitated. The overriding principle has been to keep the process as simple as possible due to the many potentially concomitant confounding influences. If the treatments applied to anorexia/cachexia do not produce profound results in the presence of substantial systemic noise, then they are not likely to be seen as efficacious in the community clinical environment beyond the clinical trials setting.

There are three services that a palliative care team may be specifically involved with: the pain clinic, radiotherapy, and medical oncology. This chapter reviews the contribution of these services to the care of patients with advanced cancer. The pain clinic and oncology services have an important role in treating pain and other symptoms of advanced cancer. Obviously, the role of the palliative care team can overlap with these services. There is the potential for misunderstanding and conflict; although such services may feel threatened by a palliative care team, the problem is not one-sided. If palliative care team members have not worked in a pain clinic or oncology ward, they may be ignorant of the benefits these services can offer. The chapter also considers the available techniques, hormone and chemotherapy, and working with oncology services.

Increasing attention has been directed towards survivorship issues for individuals diagnosed with cancer. Preliminary research has shown that appropriately prescribed exercise training programs are associated with low complication rates and numerous beneficial effects. On the basis of current evidence, the American Cancer Society recommends that cancer survivors participate in regular physical activity. This chapter provides an overview of exercise as an intervention in the rehabilitation of cancer patients and cancer survivors and includes recommendations for exercise programming based on research evidence and clinical experience. First, it provides definitions and benefits of physical activity and exercise, and then discusses common side effects from cancer treatment that may require consideration prior to exercise testing and programming. It also considers exercise prescription options for the post-cancer treatment rehabilitation phase, including cardiorespiratory exercise training, resistance exercise training, and flexibility training. Finally, precautions and contraindications to exercise are discussed.

One in every four people in the United Kingdom dies from cancer. This dreaded disease develops in over 50 per cent in the population aged 65 and above while more than 20 per cent of people aged 75 and more are affected by it. The commonest cause of death among the populace was lung cancer, a disease attributed to life. Before the 20th century, it caused a mortality rate of 23 per cent. Prostate cancer, the second most common cause of cancer death, causes death in men between the ages of 75 and 79 years old. In contrast, breast cancer, which is the most prevalent cancer disease in women, affects the younger strata, often causing deaths in those aged 35–54 years. The third most common cause of cancer death is colorectal cancer. There has been little change in the mortality rates over the past years. Other cancer diseases such as stomach cancers, bladder cancers, testicular cancers, and leukaemia have caused a lower number of deaths over the years. This chapter focuses on death caused by cancer diseases. The first death-causing factor tackled in this chapter is cancer treatment. Here, the invasive treatment methods, drug side effects, and the long-term effect of cancer treatment that may lead to the increasing incidence of death are detailed. The main causes of death in cancer patients are emphasized as well. Focus is directed to the most prevalent causes of death in patients with cancer, such as infection (e.g. sepsis and pneumonia), thromboembolism, cachexia, haemorrhage, and specific organ failure.

Despite advances in anti-cancer treatments, most adult cancer patients still eventually die from their disease. For these patients, the goal of care changes from curative to palliative at some point along the disease trajectory. Alternatively, the goal of care may be palliative from the moment of diagnosis in patients presenting with disseminated cancer. Palliative anti-cancer treatments aim to minimise spread of cancer and disease progression, help control symptoms, and improve quality of life. Other palliative therapies include medications and interventions to relieve symptoms — including physical, psychosocial, and existential issues. Communication skills training for health professionals has been shown to improve patient outcomes in decision-making with early stage disease. Further research is needed to show whether training for health professionals will improve outcomes for patients and their families during the transition to palliative care.

Despite recent advances, the five-year survival rates for many cancers remains low, and there is a continued need for research to improve cancer outcomes. Clinical trials represent the gold standard approach to providing evidence for advances in treatment. Clinical trials are research studies designed to improve cancer prevention, diagnosis, treatment and survivorship. This research base necessarily involves enroling cancer patients and others (for example, family members for genetic linkage studies, healthy community volunteers to serve as matched controls) into clinical trials. As with any research enterprise, patients and others voluntarily enrol and maintain their status as participants in these trials. Unfortunately, many medical and surgical oncology trials have insufficient accrual rates, a problem that has plagued the implementation of clinical trials for many years. Low accrual severely hinders progress in cancer treatment and prevention. This chapter outlines issues involved in recruitment to clinical trials, describes the ethical principles underlying informed consent and suggests strategies to aid communication between healthcare providers and patients about clinical trials.

The aim of palliative care is to improve the quality of life through alleviation of tumour-related symptoms and prevention of the recurrence of these symptoms in the remaining life span of the patient. Palliative oncology is at times aimed at preventing an anticipated problem arising from the cancer disease. Discussed in this chapter are: the outcomes and end-points in palliative oncology, including the evaluation of the effect of cancer treatment; the grounds and reasons when not to administer palliative oncology and cancer treatment; and the evolving relationship between oncology and palliative care.

This article was published in a special anniversary volume of the Cancer Institute of Madras and advocates the ‘total care’ of terminally ill patients — the first use of a term that would later be so widely adopted. This is linked in turn to other aspects of cancer treatment at earlier stages of the disease, so that ‘The provision of an institution primarily devoted to what is often called terminal care should not be thought of as a separate and essentially negative part of the attack on cancer. This is not merely the phase of defeat, hard to contemplate and unrewarding to carry out. In many ways its principles are fundamentally the same as those which underlay all the other stages of care and treatment although its rewards are different’.

This chapter discusses the rise of cancer treatment research. It begins by discussing Dr. Pierre Band's career as a chemotherapist and a cancer clinical trial specialist. It then describes briefly the growth of clinical cancer research and the establishment of institutions such as the Eastern Cooperative Oncology Group (ECOG) and the European Organization for Research and Treatment of Cancer (EORTC). The chapter also provides a historical background of cancer clinical trials and the institutions that performed them. Finally, the chapter provides background information of the field of cancer therapy prior to the emergence of clinical cancer research.

This chapter focuses more narrowly on progress in cancer treatment and cancer outcomes in the elderly. It considers four cancers (prostate, breast, colorectal, and lung) that together account for over half of all new cancer cases in the elderly, and for which the elderly represent 70 percent of new cases. Trends in expenditures and outcomes among Medicare beneficiaries suggest that changes in treatment during the periods studied may have improved outcomes for some but not all cancers evaluated, and even under favorable assumptions would only be considered cost-effective for a subset of cancers. A commentary is included at the end of the chapter.

This chapter focuses on the components and implications of pharmacogenetics, which refers to the relationship between heritable variations and individual differences in drug response. Pharmacogenetics aims to alter pharmaceutical patterns in cancer treatment and other branches of medicine in accordance to the patient’s individual genome. Some commentators believe that investment in pharmacogenetics is the most effective way to deliver the public health welfare originally pledged by the Human Genome Project. The chapter aims to devise a balanced judgment about pharmacogenetics, taking into consideration not only the medical evidence but also issues about justice, patenting, and drug rationing—including issues surrounding BiDil, a controversial personalized drug.

This chapter focuses on the debates concerning the relations between the US cooperative oncology groups and the Cancer Therapy Evaluation Program (CTEP) of the Division of Cancer Treatment (DCT). It also describes the emergence of an autonomous form of research when the cooperative group program was implicitly recognized as an independent research enterprise.

This chapter considers the development of monoclonal antibodies (Mabs) for cancer treatment. In the early 1980s, many scientists were optimistic that Mabs would defeat cancer. In 1982, John Minna of the U.S. National Cancer Institute (NCI) predicted that Mabs would revolutionize cancer diagnosis within five years. The adoption of Mabs as probes for targeting and identifying the multitude of antigens on different cell types seemed to herald their use in detecting and classifying tumors on a hitherto unthinkable scale. Mabs also promised to deliver more precisely powerful tumor-cell-killing agents, such as chemotherapeutic drugs, radioactive isotopes, or toxins, and to provide a way of harnessing a patient's immune system to attack tumors. However, work in the cancer field proved less straightforward than anticipated, partly because much of the initial endeavor was undertaken by researchers in academic laboratories and clinics with limited resources. Funded by government and charitable sources, their work had only minimal support from industry. In addition, new cancer drugs faced stiff regulatory and ethical tests.

This chapter discusses legacy of monoclonal antibodies (Mabs). Mab therapeutics are some of the best-selling drugs in the world today. As of 2012 there were over thirty Mab drugs on the world market. Of these, ten had achieved blockbuster status, generating profits of more than $1 billion. These included three marketed for cancer by the Roche Group: bevacizumab (Avastin), rituximab (Rituxan), and trastuzumab (Herceptin), which collectively raised $17 billion in annual revenue in 2009. Mabs have helped advance cancer research and treatment; transformed the management of autoimmune disorders; provided a major tool for understanding the onset and progression of autoimmune diseases and revealed new therapeutic possibilities; and facilitated a paradigm shift in the treatment of autoimmune diseases away from just treating symptoms to targeting and preventing their cause. Mabs were also instrumental historically in the identification and utilization of hematopoietic stem cells (HSCs), immature cells found in bone marrow, to improve the treatment of leukemia.

This chapter discusses how the 5-year survival rates for the most common cancers in the United States improved by nearly 20% since the 1970s. While promising overall, low survival rates persist for pancreatic, liver, lung, esophageal, brain, and many other cancers. Meanwhile, 5-year survival for uterine and cervical cancers worsened. Pancreatic cancer has the lowest 5-year survival rate at 8.2%. In contrast, prostate cancer had the greatest 5-year survival increase from 67.8% to 98.6%, most likely reflecting a substantial uptick in prostate cancer screening and early detection. Five-year survival with leukemia also improved significantly, from 34.2% to 60.6%, likely resulting from improved treatments. As such, in both detection and treatment, the United States is making progress. For the millions of Americans who face a cancer diagnosis, this is cause for hope.

This chapter examines the costs (medical costs, banquets and mourning costs) incurred by the cancer sufferer's nuclear and extended families in dealing with the illness by comparing Gandie's case with that of Uncle Wang. It considers the link between family relations and family caregiving practices, what kinds of health care costs are entailed when a relative develops cancer, and who shoulders them. It shows that cancer-related expenditures vary significantly depending on family composition, income, and family members' attitudes and attachment to the sufferer. It argues that a comprehensive account of the cost of illness should include not only expenditure on cancer treatment and mourning rituals and banquets but also costs of travel for visiting relatives, lost working days, medical expenses for distressed members of the family, and loss of earnings caused by diverting energies to caring for a sick relative.